Healthcare Provider Details

I. General information

NPI: 1649888603
Provider Name (Legal Business Name): MARIA PAULA GARCIA BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E 250 S HPER EAST, ROOM 208
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

1860 E 250 S HPER EAST, ROOM 208
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: